Issues‎ > ‎Vol5n2‎ > ‎

jsmc-10072


OUTCOME OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AT KURDISTAN CENTER FOR GASTROENTEROLOGY AND HEPATOLOGY / IRAQ


Ali Fadhil Alnajjar *, Taha A Alkarboly ** and Ali A Ramadhan ***


*    Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.
**  Department of Medicine, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.
*** Department of Medicine, School of Medicine, Faculty of Medical Sciences, University of Duhok, Duhok.


Submitted: 10/10/2014; Accepted: 19/3/2015; Published 1/12/2015


ABSTRACT


Background

Endoscopic retrograde cholangiopancreatography (ERCP) has an increasing role in the management of pancreatico-biliary diseases. Local data regarding the use of ERCP are limited.

Objective

To review the indications, interventions and complications of endoscopic retrograde cholangiopancreatography.

Patients and Methods

This retrospective case series was carried out in Kurdistan center for gastroenterology and hepatology in Sulaimani city – Iraq from January 2010 to December 2010. Records of 290 patients were retrospectively evaluated to collect demographic, clinical and procedure related data.

Results

The age range was 3-90 years (mean: 46.5 years), with a female to male ratio of 1.7:1. The most common indications for ERCP were choledocholithiasis (N=118, 40.7%) and pancreatico-biliary tumors (N=98, 33.8%). The mean duration of the ERCP procedure was 30 min (range: 15-45 min). Deep biliary cannulation was
successful in 266 patients (91.7%). Endoscopic sphincterotomy was the most common intervention performed (N=224, 84.2%), followed by stenting (N=92, 34.6%). The most common complication was pancreatitis (N=9, 3.1%) followed by bleeding (N=7, 2.4%). No deaths were reported.

Conclusion

Despite its associated morbidity and risk of mortality, ERCP is an important method in managing pancreaticobiliary diseases. Our indications, interventions and complications rates are comparable to those reported in other countries.

KEYWORDS

ERCP, Sulaimani, Endoscopic sphincterotomy, Choledocholithiasis.

References 

1. Huang LY, Liu YX, Wu CR. Application of endoscopic retrograde cholangiopancreatography in biliarypancreatic diseases. Chinese Med J. 2009; 122: 2967-2972.

2. Adler DG, Baron TH, Davila RE. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005; 62 (1):1-8.

3. Chavalitdhamrong D, Donepudi S, Pu L. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Digestive Endoscopy. 2014; 26: 15–22.

4. Penaloza-Ramirez A, Leal-Buitrago C, Rodriguez-Hernandez A. Adverse events of ERCP at San Jose Hospital of Bogota (Colombia). Rev Esp Enferm Dig. 2009; 101: 837-849.

5. Mohammad Alizadeh AH, Afzali ES, Mousavi M, Moaddab Y, Zali MR. Endoscopic retrograde cholangiopancreatography outcome from a single referral center in Iran. Hepatobiliary Pancreat Dis Int. 2010; 9: 428-432.

6. Mitra V, Mitchison H, Nylander D. Endoscopic retrograde cholangiopancreatography services can be accessible and of a high standard in a district general hospital. Frontline Gastroenterology. 2012; 3:152–156.

7. Al-Shekhani MA, Karbuli TA, Hussein HA, Alqazi NAM, Kasnazan QH, Ali AH. The role of Endoscopic retrograde cholangiopancreatography (ERCP) in the management of intrabiliary rupture of liver hydatid cysts (IBRH): Follow-up of 12 cases. Gastrointestinal endoscopy. 2014; 3(9): 533-543.

8. Hawramy TAH, Saeed KA, Qaradaghy SHS, Karboli TA, Nore BF, Bayati NHA. Sporadic incidence of Fascioliasis detected during hepatobiliary procedures: A study of 18 patients from Sulaimaniyah governorate. BMC Research Notes. 2012; 5:691.

9. Toros AB, Kesici B, Argun F, Gokcay S, Sari S, Bektas H, et al. Evaluation of Repeat ERCP: Analysis of a Four-Year Experience. J Gastroint Dig Syst. 2013; 2:116.

10. Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. Gastrointest Endosc. 2006; 63 (4): 29-34.

11.Chatterjee S, Rees C, Dwarakanath AD, Barton R, MacDonald C, Greenaway J, et al.  Endoscopic retrograde cholangiopancreatography                                                                                                                       practice in district general hospitals in NorthEast England: a Northern Regional Endoscopy Group (NREG) study. J R Coll Physicians Edinb. 2011; 41:109–13. 

12. Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg. 2010; 145: 28-33.

13. Salman B, Yýlmaz U, Kerem M, Bedirli A, Sare M, Sakrak O, et al. The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis coexisting with choledocholithiasis. J Hepatobiliary Pancreat Surg. 2009; 16: 832-836.

14. Zerem E, Omerovic S. Minimally invasive management of biliary complications after laparoscopic cholecystectomy. Eur J Intern Med. 2009; 20: 686-689.

15. Adel-Raouf A, Hamdy E, El-Hanefy E, El-Ebidy G. Endoscopic management of postoperative bile duct injuries: a single center experience. Saudi J Gastroenterol. 2010; 16: 19-24.

16. Sakai Y, Tsuyuguchi T, Ishihara T, Sugiyama H, Miyakawa K, Yukisawa S, et al. The usefulness of endoscopic transpapillary procedure in post-cholecystectomy bile duct stricture and post-cholecystectomy bile leakage. Hepatogastroenterology. 2009; 56: 978-983.

17. Aksoz K, Unsal B, Yoruk G, Buyrac Z, Haciyanli M, Akpinar Z, et al. Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy. Dig Endosc. 2009; 21: 158-161.

18. Tanaka K, Kida M. Role of endoscopy in screening of early pancreatic cancer and bile duct cancer. Dig Endosc. 2009; 21: 97-100.

19. Rabago L, Guerra I, Moran M, Quintanilla E, Collado D, Chico I, et al. Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital. Surg Endosc. 2010; 24: 1701-1706.

20. Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009; 70:80-88.

21. Ryan ME. ERCP complication rates: how low can we go? Gastrointest Endosc. 2009; 70: 89-91.

22. Tsou YK, Lin CH, Liu NJ, Tang JH, Sung KF, Cheng CL, et al. Treating delayed endoscopic sphincterotomy-induced bleeding: epinephrine injection with or without thermotherapy. World J Gastroenterol. 2009; 15: 4823-4828.